Successful Reversal of Recalcitrant Hepatic Allograft Rejection by Photopheresis

Abstract

Extracorporeal photopheresis (ECP) is an immunologic modality that has shown efficacy in the treatment of clonal T-cell diseases, including Sézary syndrome and allograft rejection. In this case report, we expand on this observation to include recalcitrant hepatic allograft rejection. A 14-year-old boy with hepatic allograft rejection refractory to high-dose corticosteroid and lymphocytolytic therapy was treated with 4 sessions of ECP over a 6-week period. After 2 sessions, a liver biopsy showed complete reversal of acute cell-mediated rejection. No opportunistic infections or other adverse events were noted. Photopheresis appears to be a safe and effective modality for the treatment of refractory hepatic allograft rejection. (Liver Transpl 2000;6:644-647.)

Extracorporeal photopheresis: Past, present, and future

“…In liver transplantation, a single patient with treatment-resistant rejection showed reversal of that rejection during ECP. 61 In addition, 5 patients with hepatic transplant showed reversal of rejection and 3 were able to reduce their dose of immunosuppressants. 62 In renal-graft rejection, ECP was able to reverse rejection and improve renal function in some patients who were refractory to conventional treatment, and to allow a reduction in additional immunosuppressive therapy.…”

Guidelines on the use of extracorporeal photopheresis

“…ECP has, over the years, been used to control rejection following face, liver and kidney transplantation. In 2007, Urbani et al .…”

Clinical applications of therapeutic apheresis

“…In liver transplantation, benefit from photopheresis was reported by Lehrer et al [59] [60]. Minimization of dosing of corticosteroids, calcineurin inhibitors, and other immunosuppressants is of special importance in hepatitis-C positive recipients, where progression of viral infection post-transplant is a major factor in subsequent mortality.…”